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Prophylactic pectoralis major muscle flap in prevention of pharyngocutaneous fistula in total laryngectomy after
Annie-Kim Gendreau-Lefèvre1, Nathalie Audet1, Scott Maltais1
1Department of Otorhinolaryngology - Head and Neck Surgery, CHU de Québec, Québec, Canada.
Background:
The purpose of this study was to assess the utility of the pectoralis major muscle flap (PMMF) in the prevention of pharyngocutaneous fistula for total laryngectomy after radiotherapy (RT) METHODS: We conducted a retrospective review of 166 patients who underwent a total laryngectomy after RT between 1998 and 2012 at the CHU de Québec.
Results:
One hundred fifteen patients underwent a total laryngectomy with primary pharyngeal closure alone and 51 patients received an onlay PMMF. The incidence of pharyngocutaneous fistula in the PMMF group was 14% compared to 36% when only primary closure was done (p = .004). However, the PMMF did not influence the treatment needed for the healing of this complication (p = 1.00). The development of pharyngocutaneous fistula increased the length of stay from 19 to 50 days (p < .0001) and delayed the initiation of oral diet from 15 to 25 days (p = .03).
Conclusion:
Nonirradiated tissue coverage should be routine in total laryngectomy after RT. PMMF is a good adjunct to prevent pharyngocutaneous fistula.
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